Request for Information Survey

* 1. How can Barth help you? (Check all That Apply)

Send me information

I have a requirement to discuss

I need a quotation

Other (please specify):

* 2. What information would you like Barth to send you? (Check all that apply)

Fabrication Build-to-Print Services

Special Machine Build-to-Print Services

Contract Production Machining Services

Machinery and Equipment Repair Services

Other (please specify):

* 3. If you are requesting a quotation, have you already received other quotations?

Yes

In Process Now

Comments:

* 4. What is your requirement for and how urgent is the timing? (Check all That Apply)

	Urgent Need	This Month	This Quarter	6 Months	12 Months
Fabrication Build-to-Print Services	Fabrication Build-to-Print Services Urgent Need	Fabrication Build-to-Print Services This Month	Fabrication Build-to-Print Services This Quarter	Fabrication Build-to-Print Services 6 Months	Fabrication Build-to-Print Services 12 Months
Special Machine Build-to-Print Services	Special Machine Build-to-Print Services Urgent Need	Special Machine Build-to-Print Services This Month	Special Machine Build-to-Print Services This Quarter	Special Machine Build-to-Print Services 6 Months	Special Machine Build-to-Print Services 12 Months
Contract Production Machining Services	Contract Production Machining Services Urgent Need	Contract Production Machining Services This Month	Contract Production Machining Services This Quarter	Contract Production Machining Services 6 Months	Contract Production Machining Services 12 Months
Machinery and Equipment Services Needs	Machinery and Equipment Services Needs Urgent Need	Machinery and Equipment Services Needs This Month	Machinery and Equipment Services Needs This Quarter	Machinery and Equipment Services Needs 6 Months	Machinery and Equipment Services Needs 12 Months

Other (please specify) / Comments:

* 5. Would you like to send us drawings and/or specifications at this time?

Yes

Review in person first

Drawings and specifications can be sent to sales@barthindustries.com.
Please send drawings in AutoCAD .dwg or .dxf format if possible. Bill of Materials in Excel are appreciated.

* 6. What is the Best Way to Contact You?

Phone

* 7. Would you like to follow Barth Industries?

	Yes	No	Maybe
On LinkedIn	On LinkedIn Yes	On LinkedIn No	On LinkedIn Maybe
On Facebook	On Facebook Yes	On Facebook No	On Facebook Maybe

If you would like to follow Barth on LinkedIn simply search for Barth under companies in the upper right corner search bar of LinkedIn. When the Barth profile appears click "Follow Company" in the box on the right side of the screen. Links to these sites can also be found on our Website at www.barthindustries.com.

* 8. How easy is it to navigate our website?

Extremely easy

Somewhat easy

Not at all easy

Have not visited yet

We welcome your comments and ideas for improvement regarding our Website

* 9. Contact Information

Name:

Company:

Address:

Address 2:

City/Town:

State:

ZIP:

Email Address:

Phone Number:

* 10. Please add me to your Mailing List

Yes

* 11. Please date stamp your request for us.
Thank you for your interest in Barth Industries Co.

Date

MM /

DD /

YYYY

Barth Industries Company
12650 Brookpark Road
Cleveland, OH 44130
Phone: (216) 267-1950
Fax: (216) 267-1966
www.barthindustries.com
sales@barthindustries.com